Evaluation of IL-2 and Dexamethasone intracavitary injection on the management of malignant effusion in children with solid tumors or lymphoma

Abstract Background Currently, no available coherent management protocol exists for pediatric cancers associated with pleural effusion, ascites, and pericardial effusion. This study aimed to retrospectively present our experience in treating pediatric cancer patients with pleural effusion, ascites, and pericardial effusion using interleukin-2 (IL-2) and dexamethasone (DEX) intracavitary injections. Methods Between January 1st, 2008 and December 31st, 2020, medical reports of patients diagnosed with solid tumors or lymphoma were checked to identify patients diagnosed with > 2 cm pleural effusion, and/or more than grade 1 ascites, and/or more than small pericardial effusion. Patients diagnosed with effusions and treated with IL-2 and DEX were identified as being in the effusion group. Meanwhile, patients with the same primary tumors and effusions but did not receive interleukin 2 and DEX injection were reviewed and classified as the control group. Results Forty patients with solid tumors and 66 patients with lymphoma were further diagnosed with pleural effusion, ascites, or pericardial effusion. A total of 85 patients received IL-2 and DEX injection while the remaining 21 did not. The Kaplan Meier analysis revealed a significant difference between the two groups, with p < 0.01 for event free survival (EFS) and p < 0.01 for overall survival (OS), both of which had p < 0.01. Hazard ratio was found to be 0.344 for OS and 0.352 for EFS. Conclusions This retrospective study illustrates that thoracic, intraperitoneal, or pericardial intracavitary injection of DEX plus IL-2 can be an effective and safe treatment for pediatric cancers with pleural effusion, ascites, and pericardial effusion.

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Efficacy and Safety of IL-2 injection for the treatment of childhood solid tumors or lymphoma with malignant pleural effusion, ascites and pericardial effusion

10.21203/rs.3.rs-582305/v1 ◽

2021 ◽

Author(s):

Yu-Tong Zhang ◽

Xiao-dan Zhong ◽

Yan-li Gao ◽

Jian Chang

Keyword(s):

Pleural Effusion ◽

Pericardial Effusion ◽

Solid Tumors ◽

Interleukin 2 ◽

Control Group ◽

Primary Tumors ◽

Pediatric Cancers ◽

Management Protocol ◽

Significant Difference ◽

Pediatric Cancer Patients

Abstract Background Currently, no available coherent management protocol exists for pediatric cancers associated with pleural effusion, ascites, and pericardial effusion. This study aimed to retrospectively present our experience in treating pediatric cancer patients with pleural effusion, ascites, and pericardial effusion using interleukin-2 (IL-2) and dexamethasone (DEX) intracavitary injections. Methods Between January 1st, 2008 and December 31st, 2020, medical reports of patients diagnosed with solid tumors or lymphoma were checked to identify those with concurrent > 2 cm pleural effusion and/or ascites and/or pericardial effusion. Patients diagnosed with effusions and treated with IL-2 were identified as being in the effusion group. Meanwhile, patients with the same primary tumors and effusions but did not receive interleukin 2 injection were reviewed and classified as the control group. Results Forty patients with solid tumors and Sixty-six patients with lymphoma were further diagnosed with pleural effusion, ascites, or pericardial effusion. A total of eighty-five patients received IL-2 injection while the remaining twenty-one did not. When lymphoma and solid tumor patients were combined, the Kaplan Meier analysis revealed a significant difference between the two groups, with p<0.01 for event free survival (EFS) and p<0.01 for overall survival (OS), both of which had p<0.01. Hazard ratio was found to be 0.344 for OS and 0.352 for EFS. Conclusions This retrospective study illustrates that thoracic, intraperitoneal, or pericardial injection of DEX plus IL-2 can be an effective and safe treatment for pediatric cancers with pleural effusion, ascites, and pericardial effusion.

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Can IL-2R Alpha be a Valuable Marker along with Ca 19–9 in the Diagnosis of Chronic Pancreatitis and Pancreatic Cancer?

The International Journal of Biological Markers ◽

10.1177/172460080401900304 ◽

2004 ◽

Vol 19 (3) ◽

pp. 196-202

Author(s):

B. Kayhan ◽

M. Akdoğ;an

Keyword(s):

Pancreatic Cancer ◽

Chronic Pancreatitis ◽

Interleukin 2 ◽

Carbohydrate Antigen ◽

Control Group ◽

Serum Samples ◽

Cancer Group ◽

Abdominal Symptoms ◽

Significant Difference ◽

Inflammatory Processes

Background Pancreatic cancer is characterized initially by non-specific abdominal symptoms followed by rapid tumor progression. Although chronic pancreatitis is a benign disorder, it can be one of the causative factors of pancreatic cancer. The level of the tumor marker carbohydrate antigen 19–9 (CA 19–9) in pancreatic cancer does not correlate with the stage of the neoplasm. Soluble interleukin 2 receptor (sIL-2R) is a cytokine that shows increased levels during some inflammatory processes and malignant disorders. Aim Our aim in this study was to investigate whether sIL-2Rα levels can be used in association with CA 19–9 in the early diagnosis of pancreatic cancer and chronic pancreatitis. Patients Serum samples were obtained from the blood of 21 pancreatic cancer patients without distant metastasis who were deemed inoperable, 16 chronic pancreatitis patients and 20 normal volunteers. Results We did not find any significant differences in CA 19–9 levels between normal controls and patients with chronic pancreatitis. There was a significant difference in the levels between the control group and the pancreatic cancer group (p=0.003) and between patients with chronic pancreatitis and those with pancreatic cancer (p=0.004). Although there was no significant difference in sIL-2Rα levels between the control group and the patient groups, we found a slight correlation between sIL-2Rα and CA 19–9 levels in the pancreatic cancer group (p=0.003, r=0.623) and a more marked correlation in the chronic pancreatitis group (p<0.01, r=0.751). Conclusion According to our results, sIL-2Rα alone is not a good candidate marker in the diagnosis of pancreatic cancer; it can, however, be used in association with CA 19–9 for this purpose.

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Implementation and Effectiveness of Early Chest Tube Removal during an Enhanced Recovery Programme after Oesophago-gastrectomy

Journal of Nepal Medical Association ◽

10.31729/jnma.2699 ◽

2015 ◽

Vol 53 (197) ◽

pp. 24-27 ◽

Cited By ~ 2

Author(s):

Rajeev Bhandari ◽

You Yong-hao

Keyword(s):

Pleural Effusion ◽

Hospital Stay ◽

Chest Tube ◽

Enhanced Recovery ◽

Task Force ◽

Length Of Hospital Stay ◽

Control Group ◽

Tube Removal ◽

Significant Difference ◽

Chest Tube Removal

Introduction: Oesophageal resection were notoriously complicated and produces a cohort of patients prone to postoperative complications and here we would like to focus on the implementation and effectiveness of early chest tube removal in ERAS after oesophago-gastrectomy considering the various aspect like pleural effusion and reducing the length of hospital stay which ultimately lead to reducing the economic burden on patient.Methods: An ERAS programme was devised and implemented with the support of a dedicated in-hospital task-force. The patients underwent esophago-gastrectomy were randomly divided into two groups: the ERAS group and the control group (non-ERAS). The ERAS group was treated with early removal of the chest tube after surgery, and the control group was treated with traditional way and outcomes were compared between them.Results: The length of hospital stay and the cost of hospitalization in the ERAS group were significantly lower than those in the control group（p<0.05. However, there was no statistical significant difference in the incidences of pleural effusion between the two groups（p＞0.05).Conclusions: The introduction of early chest tube removal as an ERAS programme after oesophago-gastrectomy would not increase the risk of pleural effusion and would not increase the total length of stay and cost of hospitalisation without jeopardising patient safety or clinical outcomes.

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Blood Concentrations of Interleukin-15 in Cancer Patients and Their Variations during Interleukin-2 Immunotherapy: Preliminary Considerations

The International Journal of Biological Markers ◽

10.1177/172460089801300309 ◽

1998 ◽

Vol 13 (3) ◽

pp. 169-171 ◽

Cited By ~ 4

Author(s):

P. Lissoni ◽

F. Rovelli ◽

M. Mandalà ◽

S. Barni

Keyword(s):

Cancer Immunotherapy ◽

Cancer Patients ◽

Metastatic Cancer ◽

Cell Cancer ◽

Interleukin 2 ◽

Serum Levels ◽

Control Group ◽

Blood Concentrations ◽

Significant Difference ◽

Interleukin 15

In addition to the better known cytokines IL-2 and IL-12, IL-15, which is mainly produced by macrophages, is a new antitumor cytokine with a mechanism of action similar to that of IL-2. At present, however, there are no data about IL-15 secretion in cancer patients. This study was carried out to evaluate IL-15 blood concentrations in patients with early or advanced cancer and their possible variations in response to IL-2 cancer immunotherapy. The study included 40 patients with solid tumors, 24 of whom had metastatic disease. In addition, IL-15 secretion was evaluated during subcutaneous low-dose IL-2 therapy (6 million IU/day for 6 days/week for 4 weeks) in 14 metastatic renal cell cancer patients by collecting blood samples at weekly intervals. The control group consisted of 40 age-matched healthy subjects. Serum levels of IL-15 were measured by an enzyme immunoassay. No significant difference in mean serum levels of IL-15 was observed between cancer patients and controls. Moreover, the mean serum levels of IL-15 found in metastatic cancer patients were not significantly different from those found in patients with limited disease. Finally, no significant changes in mean levels of IL-15 occurred during IL-2 cancer immunotherapy. This preliminary study would suggest that IL-15 secretion is substantially within the normal range in cancer patients, both in early and advanced disease, and no variation seems to occur in response to IL-2 administration.

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Characterization of tumor mutational burden (TMB), PD-L1, and DNA repair genes to assess correlation with immune checkpoint inhibitors (ICIs) response in metastatic renal cell carcinoma (mRCC).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16079 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16079-e16079 ◽

Cited By ~ 2

Author(s):

Matthew Labriola ◽

Jason Zhu ◽

Rajan Gupta ◽

Shannon McCall ◽

Jennifer Jackson ◽

...

Keyword(s):

Dna Repair ◽

Checkpoint Inhibitors ◽

Predictive Biomarkers ◽

Metastatic Tumor ◽

Control Group ◽

Personal Genome ◽

Dna Repair Genes ◽

Primary Tumors ◽

Significant Difference ◽

Repair Genes

e16079 Background: ICIs have revolutionized treatment for mRCC; however there are limited predictive biomarkers for response to ICIs. PD-L1 status is still controversial, demonstrating little predictive utility in mRCC. TMB is predictive for response to ICIs in melanoma and non-small cell lung cancer (NSCLC), but has not been validated in mRCC. Here, we assess the correlations between TMB and PD-L1 status with outcomes to ICI treatment in mRCC. Methods: 34 patients (pts) with mRCC who had previously received ICIs at Duke Cancer Institute were identified. Tumor samples were retrospectively evaluated using a Personal Genome Diagnostics Assay for somatic variants across > 500 genes, as well as TMB and microsatellite status. PD-L1 status was tested via the Dako 28-8 PD-L1 IHC assay. Deidentified clinical information was extracted from the medical record and tumor response was evaluated based on RECIST criteria. Results: Pts were grouped by overall response following ICI therapy into either progressive disease (“PD”, n = 18) or disease control group (“DC”, n = 16), defined as either stable disease, partial response, or complete response. Pts displayed a TMB range from 0.36 to 12.24 mutations/Mb with a mean score of 2.83 muts/Mb, with no significant difference between the PD and DC groups (mean 3.01 muts/Mb vs. 2.63 muts/Mb, p > 0.05). 9 of 32 evaluable samples were PD-L1 positive, with 4 in the PD group and 5 in the DC group. Notably, the DC group displayed a significant enrichment of mutations in genes affiliated with DNA repair (including BRCA1, BRCA2, FANCA, FANCB, FANCG, FANCM, MSH3, MSH6, RAD50, RAD51C, RAD51D, RAD54B, RECQL4, and SLX4; p = 0.0444). DNA damage gene mutations were found in 8/10 (80%) metastatic tumor specimens and 14/24 (58%) primary tumors. Conclusions: Overall, in this mRCC cohort, neither TMB nor PD-L1 correlated with patient outcomes or with ICI response. Furthermore, high TMB was not significantly associated with PD-L1 expression within the samples. The higher frequency of mutations in DNA repair genes in the DC group suggests potential use as a predictive signature for ICI response, warranting future prospective studies. Further studies with matched primary-metastatic samples would be beneficial to determine if DNA repair mutations occur more frequently in metastatic versus primary tumor specimens.

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Paracrine Suppression of VEGF Secretion by Erythropoietin Inhibits Tumor Growth.

Blood ◽

10.1182/blood.v110.11.3909.3909 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3909-3909

Author(s):

Carroll R. Smith ◽

Kenneth J. Salleng ◽

Vaia Y. Sigounas ◽

Adam Asch ◽

George Sigounas

Keyword(s):

Tumor Growth ◽

Lung Carcinoma ◽

Lewis Lung Carcinoma ◽

Lung Metastases ◽

Control Group ◽

Lewis Lung ◽

Average Volume ◽

Primary Tumors ◽

Significant Difference

Abstract Several studies have reported that erythropoietin (Epo) is a pleiotropic cytokine with biological properties in addition to its primary function in regulating maturation, growth and survival along the erythroid lineage. Recently, a number of investigators have reported that various neoplastic tissues and human cancer cell lines express Epo and the Epo receptor (EpoR), raising suspicion for the presence of an autocrine-paracrine Epo-EpoR system. It has been shown that inhibition of vascular endothelial growth factor (VEGF) results in an increase of Epo secretion and increased hematocrit in vivo. In this study, we used an in vivo Lewis lung carcinoma model to examine a converse Epo effect on VEGF production and metastasis. Lewis lung carcinoma (LLC) cells were injected subcutaneously into C57BL mice. The plasma levels of VEGF, the tumor vessel formation, the size of the primary tumors and the extent of lung metastatic disease were determined. In addition, intravenously injected LLC cells seeded in the lungs were assessed. Tumor-bearing animals treated with Epo had 23.6% less VEGF in the plasma compared to saline treated mice (p<0.04). There was no correlation between VEGF concentration and hemoglobin levels in either group of animals. Tumor sections indicated that the number of blood vessels was higher (10.7% for inner and 23.8% for outer, respectively) in tumors obtained from animals treated with saline compared to Epo-treated mice (p>0.05). Using non-parametric analysis, we found that there was a statistically significant difference in tumor growth between saline-treated and Epo-treated animals (p<0.05). However, the number of lung metastases derived from primary tumors was similar in both groups. In assessing size of the metastatic tumors, we found that the average volume of lung nodules was 24.2% higher in saline-injected animals compared to Epo-treated mice. The number of tumors seeded in the lungs following intravenous injection of LLC cells was similar in animals treated with a high dosage of Epo, low dosage of Epo or saline. In addition, the average volume of the nodules was reduced by 42% in animals treated with high and low concentrations of Epo compared to the control group (p = 0.03). In conclusion, Epo exerts a paracrine suppressive effect on VEGF secretion resulting in slower tumor growth in this model.

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Phenylephrine Effectiveness in Handling Hypotensive Issues During Spinal Anesthesia Conductance for Cesarean Section Deliveries

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm.04.03.02 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Research Group ◽

Elective Cesarean Section ◽

Control Group ◽

P Values ◽

Management Protocol ◽

Significant Difference ◽

Elective Cesarean ◽

The Impact

Background: Hypotension is frequent clinical challenge during spinal mode of anesthetic induction for cesarean delivery. Requiring an effective and prompt management mode since it has unfavorable clinical outcomes such as hemodynamic cardiovascular instability issues besides reduced uteroplacental perfusion. Aim: Investigating the impact and effectiveness of different prophylacticdosages of Phenylephrine on hypotensive issues during spinal anesthesia for cesarean section deliveries. Methodology:A prospective, randomized, clinical research study involved 184 cases That are classified as American Society of Anesthesiologists physical status I and II with term singleton pregnancies scheduled for elective cesarean section under spinal anesthesia randomized to receive 0.9% saline 2 mL (Control Group) or phenylephrine1.0 ug/kg (PHE1 research Group), 1.5 ug/kg (PHE1.5 research Group), or 2.0 ug/kg (PHE2 research Group) immediately after induction of spinal anesthesia. Results: The adverse effects of prophylactic bolus ofPhenylephrine among the research groups control, Phenylephrine 1, 1.5,2 in which there was statistically significant difference as regards hypotension, rescue Phenylephrine,lowest SBP,highest SBP,early highest SBP,mean SBP, occurrence of hypertension (p values= <0.001, <0.001, 0.002, <0.001, <0.001, <0.001, <0.001consecutively) there was no statistical significant difference as regards nausea and bradycardia (p values=0.929, 0.823consecutively). Conclusions: The research findings obtained denote and imply that a prophylactic Phenylephrine 1.5 ug/kg bolus followed by additional boluses when necessary could be an alternative management protocol to decrease the frequency of hypotensive issues occurrence during spinal anesthetic mode for cesarean deliveries.

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Determination of Highest Dose of Ammonia without Effect at Work Environment through the Expression of Interleukin-2 Cell in Rattus Novergicus

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.207 ◽

2019 ◽

Vol 7 (6) ◽

pp. 897-902

Author(s):

Abdul Rohim Tualeka ◽

Dwi Ananto Wibrata ◽

Ahsan Ahsan ◽

Pudji Rahmawati ◽

Syamsiar S Russeng ◽

...

Keyword(s):

Body Weight ◽

Statistical Tests ◽

Interleukin 2 ◽

Threshold Limit Value ◽

Laboratory Research ◽

Control Group ◽

Control Group Design ◽

Limit Value ◽

Significant Difference

BACKGROUND: For determining the threshold limit value firstly determined the highest dose of ammonia without effect (NOAEL). However, research on the determination of NOAEL ammonia didn't conduct in Indonesia. AIM: The aim of this study to determine the value of the highest dose of ammonia without effect (No Observed Adverse Effect Level/NOAEL) through interleukin-2 (IL-2) expression on white mice. METHODS: This study used experimental laboratory research with post-test only control group design using white mice as experimental subjects. The treatment group divided into 6 groups (a group of controls and five groups with different ammonia exposure through inhalation). The trend curve of Remmele Scale Index (IRS) and histopathologic analysis could be used for determining NOAEL. RESULT: The location of the highest dose of ammonia without any effect (NOAEL) of white mice was in the second group, with 0.0103 mg/kg body weight dose. Analysis of statistical tests Kruskal Wallis stated there was no significant difference in interleukin-2 expression between the control with ammonia exposed group with a significance of p (0.747) > α (0.05). CONCLUSION: There is no difference between some interleukin-2 expression in the lymphocyte cell lung white mice group exposed to ammonia and control group. The highest dose of ammonia without any effect (NOAEL) on white mice was 0.0103 mg/kg body weight.

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Effects of Cyclosporine Therapy on Liver and Kidney Retrieval in Poisoned Male Rats by Mesobuthus eupeus Scorpion Venom

Iranian Red Crescent Medical Journal ◽

10.5812/ircmj.101105 ◽

2020 ◽

Vol 22 (6) ◽

Author(s):

Sara Zangiabadi ◽

Shahrokh Navidpour ◽

Hossein Zolfagharian ◽

Gholamhassan Vaezi

Keyword(s):

Inflammatory Responses ◽

Agricultural Research ◽

Interleukin 2 ◽

Male Rats ◽

Terminal Deoxynucleotidyl Transferase ◽

Control Group ◽

Scorpion Sting ◽

Apoptosis Rate ◽

Significant Difference ◽

Liver And Kidney

Background: Mesobuthus eupeus venom is a member of Buthidae family, which can enter the blood circulation exerting detrimental effects on body organs, such as the liver and kidney through inflammation. Cyclosporine, known as an anti-inflammatory drug, is used to treat many inflammation-associated diseases. Objectives: In this study, cyclosporine was selected to inhibit the scorpion toxin effects on rat organs. Methods: This experimental study was conducted in the Razi Vaccine and Serum Research Institute, Agricultural Research Education and Extension Organization, Karaj, Iran, from June to November 2019. Fifty male rats were randomly divided into five groups of 10, including the control (10 mg/kg olive oil i.p), M. eupeus venom (10 mg/kg i.p.), cyclosporine 10 mg/kg (venom 10 mg/kg for 30 min i.p followed by cyclosporine 10/kg mg for 7 day i.p.), cyclosporine 20 mg/kg (venom 10 mg/kg for 30 min i.p followed by cyclosporine 20 mg/kg for 7 day i.p.), and cyclosporine 30 mg/kg (venom 10 mg/kg for 30 min i.p followed by cyclosporine 30 mg/kg for 7 day i.p.). After treatment with cyclosporine, the liver and kidney function was analyzed by calculating some biochemical enzymes, including serum glutamate-pyruvate transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), nitric oxide (NO), interleukin-2 (IL-2), malondialdehyde (MDA), creatinine, and urea via ELISA and spectrophotometry. Then, to determine the rate of apoptosis in tissue, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling method was done. Results: At the end of the study, the results showed a significant elevation in SGPT (164.5 ± 10 vs. 126.2 ± 7, P < 0.0001), SGOT (190.37 ± 11 vs. 148 ± 10, P < 0.0001), NO (24.4 ± 1.17 vs. 17.4 ± 1.4, P = 0.02), and MDA (0.42 ± 0.05 vs. 0.22 ± 0.04, P < 0.0001) in the venom group compared with the control group. There were no significant differences in the urea, IL-2, and creatinine between the venom and control groups. However, the group receiving cyclosporine (30 mg/kg) showed a significant decline in SGPT (96.42 ± 5.7 vs. 164.5 ± 10, P < 0.0001), SGOT (144.57 ± 9.24 vs. 190.37 ± 11, P < 0.0001), urea (28.83 ± 1.32 vs. 38.83 ± 1.6, P = 0.00), creatinine (0.023 ± 0.01vs. 0.29 ± 0.005, P < 0.0001), and MDA (0.10 ± 0.01 vs. 0.42 ± 0.05, P < 0.0001), as well as increased apoptosis rate (P < 0.05), compared with the venom group. No significant difference was observed between the cyclosporine and venom groups in NO and IL-2. Conclusions: Cyclosporine at a dose of 30 mg was able to decrease inflammatory responses and induce apoptosis rate. Therefore, it could be a suitable drug for patients bitten by a scorpion sting.

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Delayed Versus Initial Risk-Categorization of Pediatric Cancer Patients with Prolonged Febrile Neutropenia. A Randomized, Prospective Clinical Trial.

Blood ◽

10.1182/blood.v106.11.3119.3119 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3119-3119

Author(s):

Nabil M. Ahmed ◽

Hadir El Mahallawy ◽

Alaa M. El Haddad

Keyword(s):

High Risk ◽

Pediatric Cancer ◽

Early Discharge ◽

Blood Cultures ◽

Control Group ◽

Outpatient Therapy ◽

Significant Difference ◽

Pediatric Cancer Patients ◽

Duration Of Hospitalization ◽

Risk Categorization

Abstract Purpose: Hospitalization with empiric broad spectrum intravenous antibiotics has been the standard of care for treatment of high-risk febrile neutropenia. In an attempt to improved hospital utilization we attempt to identify a group of patients at a lower risk of sepsis that would be eligible for outpatient therapy. We hypothesized that patients initially considered at high risk for sepsis can be candidates for outpatient therapy if at 72 hours satisfied certain selection criteria. Patients and methods: A prospective, randomized clinical trial was conducted in 119 febrile neutropenic pediatric cancer patients. Patients were randomized into two groups depending on the time of risk-categorization: Initial (control) vs. delayed (study) groups. Patients in the study group were risk-assessed at 72 hours and accordingly considered for outpatient therapy if afebrile, had an absolute neutrophil count (ANC) > 100/uL, negative blood cultures, and no signs of infection among other carefully defined “Early Discharge Criteria”. Those randomized to the control group were treated in the hospital. We analyzed the clinical features, microbiological data, hospital course, duration of hospitalization and treatment cost. Intention-to-treat analysis was used. Results: We found a statistically significant difference between the duration of hospitalization in the group risk-assessed at 72 hours and control group (p<0.01). “Delayed Risk-categorization” correlated better with the duration of neutropenia, need for antibiotic change and episode outcome. Duration of hospitalization and per-episode median treatment cost were significantly less in the study group vs. control (p< 0.001). There was a significant tendency for blood cultures to cluster around the first 48 hours. Comparing the blood culture yield between patients treated in the hospital to those treated as outpatients after risk-assessment at 72 hours there was no statistically significant difference demonstrated [p=0.35]. Readmission rate after early discharge was 3.3%. Conclusion: We conclude that pediatric febrile-neutropenic patients initially at considered at “high risk for sepsis” can be reevaluated at 72 hours for outpatient therapy. The practice of “Delayed Risk-Categoriztion” could be particularly useful to reduce the overall treatment costs, and duration of hospitalization. In addition, this practice could potenitally offer a superior quality of life.

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